Provider Demographics
NPI:1326370644
Name:YAKAMA NATION
Entity type:Organization
Organization Name:YAKAMA NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DREWS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-865-7961
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948
Mailing Address - Country:US
Mailing Address - Phone:509-865-7961
Mailing Address - Fax:509-865-2195
Practice Address - Street 1:171 WISHPOOSH ROAD #28
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948
Practice Address - Country:US
Practice Address - Phone:509-865-7961
Practice Address - Fax:509-865-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60123614251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1981265Medicaid